Prevention of Future Deaths reports · 2018

Novia Delima

Regulation 28 report to prevent future deaths, reference 2018-0112, written 20 Apr 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report20 Apr 2018
Reference2018-0112
DeceasedNovia Delima
CoronerAlison Mutch
Coroner areaManchester South
CategoryChild Death (from 2015) · Hospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

REGULATION 28: REPORT TO PREVENT FUTURE DEATHS

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: The Secretary of State for Health, the Chief
Executive of NHS England and the Mayor of Greater Manchester

CORONER

lam Alison Mutch, Senior Coroner, for the coroner area of South Manchester

CORONER’S LEGAL POWERS

| make this report under paragraph 7, Schedule 5, of the Coroners and Justice
Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations
2013

INVESTIGATION and INQUEST

On 27" July 2016 | commenced an investigation into the death of Novia Emilia
Delima. The investigation concluded on the 17" April 2018 and the conclusion
was one of narrative: Died of the recognised complications of sepsis contributed
to by neglect.

The medical cause of death was Neonatal Herpes Simplex (Type I), E coli
septicaemia

CIRCUMSTANCES OF THE DEATH

Novia Emilia Delima's mother brought her to Tameside General Hospital on 25th
July 2016 at 01:48 because she had two episodes of blood in her nappies, was
sleepy and not feeding properly. At 02:03 Novia was triaged using the
Manchester triage tool. The system identified her as orange category requiring
she see a doctor within 10 minutes. A junior doctor saw her about 05:35, three
and a half hours after triage. In the intervening period basic observations but
no tests were carried out and no treatment commenced. Further blood had
been seen in the nappy. On examination, blood was seen coming from the
rectum. Transfer was made to the Paediatric department; Novia arrived there
at 06:30, four and a half hours after her arrival at Tameside General Hospital.
She was very unwell. Sepsis was identified. Treatment was given including
antiviral and antibiotic medication. Novia continued to deteriorate and died at
12:03 at Tameside General Hospital. She had died from a combination of
neonatal herpes simplex and E coli septicaemia.

CORONER'S CONCERNS

During the course of the inquest the evidence revealed matters giving rise to
concern. In my opinion, there is a risk that future deaths will occur unless action
is taken. In the circumstances, it is my statutory duty to report to you.

The MATTERS OF CONCERN are as follows:

1. The Trust had adopted the Manchester triage system but due to demand on
the ED the time identified through the triage system could not be met. The
Manchester triage tool is widely used but the inquest heard that often across
EDs the targets set by the triage tool are not met;

2. The inquest heard that very young babies present significant challenges in
diagnosis and early clinical input by a clinician experienced in dealing with
young children was important. The trust had brought in significant changes to
how it dealt with paediatric cases in ED since the death of Novia. This includes
early clinical involvement of a paediatric clinician for babies between 0- 6
months due to their recognition of challenges of diagnosis in very young
children. The inquest heard that not all trusts, nationally, have systems that
ensure very young children are seen by a paediatrician at an early stage
particularly in an OOH situation.

3.0n the night in question the inquest heard that a consultant was on call for ED
but was not called in despite the significant delays in ED. The inquest heard that
the ED on call consultant arrangements meant that long wait times would not in
themselves trigger on call consultants being asked to attend the hospital.

ACTION SHOULD BE TAKEN

In my opinion, action should be taken to prevent future deaths and | believe you
have the power to take such action.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this
report, namely by 15th June 2018. I, the coroner, may extend the period.

Your response must contain details of action taken or proposed to be taken,
setting out the timetable for action. Otherwise you must explain why no action

is proposed.

COPIES and PUBLICATION

| have sent a copy of my report to the Chief Coroner and to the following
Interested Persons namel Mother of the deceased, who may find
it useful or of interest.

lam also under a duty to send the Chief Coroner a copy of your response.

Nw

The Chief Coroner may publish either or both in a complete or redacted or
summary form. He may send a copy of this report to any person who he
believes may find it useful! or of interest. You may make representations to me,
the coroner, at the time of your response, about the release or the publication
of your response by the Chief Coroner.

Alison Mutch OBE
HM Senior Coroner
20/04/2018

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